Simon Lee Dental

Primary specialty

DentistTaxonomy code 122300000X

License

37978 Issued in CA

Legal business name

SIMON LEE DENTAL

Practice address

15130 Lakeshore Dr
Clearlake, CA 95422

Phone

(707) 994-6000

Fax

(707) 994-7589

NPI assigned

Aug 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Simon Hyun Lee

Title

Owner

Phone

(707) 994-6000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295845717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15130 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "95422",
            "telephone_number": "707-994-6000",
            "fax_number": "707-994-7589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15130 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "95422",
            "telephone_number": "707-994-6000",
            "fax_number": "707-994-7589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMON LEE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SIMON",
        "authorized_official_middle_name": "HYUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-994-6000"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "37978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "G9342001",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ariel Verane Serre
• Robert William Sexton
• Marc Randall Shapiro, MD
• Hassan Sheikh Moghaddas, M.D
• Samuel David Sheridan
• Dennis Barton Skinner, MFT
• Megan L Smith, MD
• Michael Smith
• Stacy Lucille Smith
• Katarzyna Sobczynska, M.D

• Dentist in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.